Trauma Clinic Research Articles

1549 Patient Perception on Hand Trauma Management Through a Plastic Surgery Trauma Clinic

Abstract Aim We assessed patient perceptions of hand trauma management through a plastic surgery trauma clinic. We also assessed effects of educating patients about outcomes of their condition on their desire to have prompt surgery. Method A prospective survey review was conducted at our plastic surgery trauma clinic. Patients included were those referred due to simple hand trauma. Any patients needing urgent admissions were excluded. An anonymous survey assessing patient perceptions before and after education about delay in surgery was distributed. Results Of 100 patients, there were mixed expectations regarding trauma clinic; 38% (n = 38) expect an operation, 32% (n = 32) expect no operation and 30% (n = 30) expect either option. 90% (n = 90) expect surgery within a week (50% n = 50) or within a day (40% n = 40); 10% expect it (n = 10) within a few weeks. After educating patients about no negative effects on their condition from surgical delay, 43% (n = 17) fewer patients desired surgery within a day, and 8% (n = 3) fewer patients desired surgery within a week. 190% (n = 19) more patients were willing to have surgery within a few weeks. 79% (n = 79) would rather come back at a guaranteed surgical slot than stay in hospital until a slot is available. 72% (n = 72) considered knowledge about long-term outcomes associated with surgical delay to influence their decision more than anaesthetic type (12% n = 12) and personal circumstances (16% n = 16). Conclusions If appropriate patients are assured that their condition will not be affected by surgical delay, fewer patients may stay in hospital with financial benefits of reduced bed occupancy and reduced covid risks.

1126 Improving Hand Trauma Clerking Using an Electronic Proforma: A Full Cycle Clinical Audit

Abstract Aim The BSSH standards of care in hand trauma emphasise the importance of accurate and comprehensive documentation. This quality improvement project aimed to evaluate whether an electronic proforma could improve documentation rates in hand trauma. Method This prospective, closed-loop audit involved two cycles of seven consecutive days. Outcomes were evaluated against BSSH standards of care using 15 data points. Pre-audit, a bespoke proforma was piloted in the hand trauma clinic and revised following feedback. In the first cycle (‘Loop 1’), documentation in the hand trauma clinic was compared with that of the acute take, where clinicians were still using free text. The second cycle (‘Loop 2’) compared documentation pre- and post-introduction of the proforma within the acute take setting. Categorical data were interrogated using the χ2 test with significance set at p < 0.05. Results 122 patients were included in the Loop 1 dataset. Free text clerking quality varied between clinician groups (e.g., surgical trainees significantly outperformed advanced nurse practitioners in 5/15 data points); however, some data points were universally poorly documented. 99 patients were included in the Loop 2 dataset. There was excellent uptake of the proforma in both acute take (95%) and hand trauma clinic (100%) settings. Statistically significant improvements were seen in 11/15 data points following the introduction of the proforma. Conclusions This project demonstrates that the introduction of a hand trauma clerking proforma led to significant improvements in documentation quality. The proforma has now been developed into a Trust-wide ClinDoc which brings additional benefits in terms of research, audit and service evaluation.

377 Expanding the Use of Wide-Awake Local Anaesthesia Non-Tourniquet (WALANT) Technique in The Management of Hand Trauma Patients During the COVID 19 Pandemic

AimCOVID19 produced a unique challenge to the management of hand trauma. There was reduced theatre capacity and inpatient beds as staff and resources were lost to make way for the critically unwell1, however the burden of patients (albeit reduced) requiring emergency procedures remained2. During 1stUK peak we adopted a one-stop hand trauma clinic where patients were assessed by senior surgeons and immediately operated on under local anaesthesia with Adrenalin, a model mirrored by other units across the UK during this time3,4. Subsequent to surgery they were either seen on the same day for advice with a hand therapist or booked for immediate hand therapy follow up.MethodA retrospective review of 158 cases operated on over a 4-month COVID19 period compared to the same 4-month period 1 year previously. Indications for surgery and type of anaesthesia were recorded. Follow up and complication rates were reviewed for the COVID19 patients.ResultsThere were similarities in the demographic of patients across both cohorts and in mechanism of injury, with trauma the highest indication for surgery. The comparable data sets showed only 21% of patients treated used WALANT pre-COVID19 versus 100% of patient during COVID19.ConclusionsWALANT is a viable model by which to perform emergency hand trauma surgery in a low cost and low resource setting. Previously this model was not utilised to full effect in our hospital. The results demonstrate the adaptability of WALANT in an adverse and dynamic situation, such as COVID19, thus highlighting benefits to patient care and service provision.

Incidence and risk factors of occult posterior malleolar fracture in patients with spiral distal tibial fracture: Reexamination and analysis

ObjectiveTo evaluate the incidence and risk factors for posterior malleolar fractures (PMFs) in patients with spiral distal tibial fractures (SDTFs). MethodsIn a retrospective study, 248 adults with SDTFs who underwent treatment were enrolled between November 2017 and May 2020. In a prospective study, we recruited 113 consecutive, skeletally mature patients with SDTFs who were identified from the trauma clinic of our hospital between June 2020 and May 2021. Radiographs and CT scans of the ankle region on the affected side were obtained to determine the presence of PMFs. If the CT scan was negative, additional MRI examination of the ankle was performed as a supplementary protocol in the prospective study. Univariate analysis and multivariate analysis were conducted to analyze the risk factors. ResultsIn the retrospective study, the incidence of PMFs associated with simple SDTFs was 74.0% (105/142), which was significantly lower than 90.8% (69/76) in the prospective study. Independent predictors of PMFs in patients with simple SDTFs identified by multivariate analysis in the retrospective study were age (OR = 1.07; P = 0.001) and external rotation of the proximal tibia (OR = 3.36; P = 0.027) and those in the prospective study were osteoporosis (OR = 0.04; P = 0.007) and spiral fibula fractures (OR = 16.05; P = 0.046). ConclusionThis study reexamined the high incidence of concurrent PMFs. Additionally, ankle radiographs and CT scans were recommended for all simple SDTF patients. For simple SDTF patients with negative CT scans, especially those caused by external rotation of the proximal tibia, combined with nonosteoporotic or spiral fibula fractures, additional MRI examinations are recommended.

An investigation of transitional care pathways for young people following traumatic dental injuries.

Introduction Traumatic dental injuries (TDIs) can cause severe and complex dento-alveolar problems. Management of TDIs frequently extends into adulthood; therefore, a clear transitional care pathway (TCP) is important. Failure of this can prevent engagement in adult dental services and negatively influence treatment outcomes.Aims To assess the availability of TCPs from paediatric and adult specialist care for young people with TDIs.Materials and methods An anonymous, postal survey was designed and administered to all UK specialists in paediatric dentistry registered with the General Dental Council. Quantitative and qualitative data were gathered.Results The response rate was 58% (n = 130). Fifty-five percent (n = 72) stated that there was a dental trauma clinic for children within their locality, while only 22% (n = 29) stated that there was a dental trauma clinic for adults. Sixty-nine percent (n = 90) stated that there was no clear TCP within their locality and 41% (n = 37) of these highlighted a need for a TCP. Thematic analysis of opinions with regards to need for a TCP identified three main themes: pathway availability, access to resources and clinician experience. Following a course of treatment for a patient aged 12 years or above, 24% (n = 31) refer to specialist adult services, with 43% (n = 95) continuing to provide follow-up within paediatric dentistry.Conclusion Follow-up arrangements for young people with TDIs differ across the UK, with inconsistent availability of TCPs. Informal pathways involving referral to multidisciplinary teams may be utilised for follow-up care. Development of a TCP may aid in developing a consistent approach to long-term management of TDIs.

Racial, ethnic, and neighborhood income disparities in childhood posttraumatic stress and grief: Exploring indirect effects through trauma exposure and bereavement.

Previous findings suggest that experiences with systems of oppression that disproportionately affect individuals based on race and neighborhood residency (e.g., systemic racism, neighborhood income disadvantage [NID]) can be associated with higher odds of developing psychological problems following traumatic events. Although race/ethnicity and NID residency are often associated, they are separate concepts that play unique roles in mental health outcomes among youth. Residents of Black, Latinx, and income-disadvantaged communities also have an increased risk of exposure to polyvictimization and the loss of multiple loved ones. Studies have not carefully delineated the potential relations between race/ethnicity and NID residency, polyvictimization, accumulated losses, and trauma and grief outcomes in youth. We examined mediation models to investigate whether polyvictimization, the loss of multiple loved ones, and exposure to violent death were potential mechanisms through which race/ethnicity and NID would predict trauma and grief outcomes in youth. Participants (N = 429) included Black (19.9%), Latinx (36.0%), and White (27.3%) children and adolescents who were assessed through a routine baseline assessment at a trauma and grief outpatient clinic. Black youth reported significantly elevated posttraumatic stress and maladaptive grief symptoms through higher polyvictimization and violent death exposure relative to White youth, βs = .06-.12, ps <.001. Latinx identity and NID were positively and directly associated with specific domains of maladaptive grief reactions, βs = .10-.17, ps < .001. If replicated longitudinally, these findings suggest that polyvictimization and violent death exposure may be mechanisms through which Black youth develop more severe traumatic stress and grief reactions.

Dental undergraduate students' ability in the diagnosis of root fractures: Comparative analysis of different imaging methods

The aim of this study was to evaluate the diagnostic ability of dental undergraduate students to detect horizontal and oblique root fractures (ORFs) using different imaging techniques. Nine teeth were selected and randomly divided in three groups in order to create a fracture line without fragments separation: control (without fracture), horizontal root fracture (HRF), and ORF. The root fracture was created using perpendicular force and was confirmed by transillumination. A model with two adjacent teeth was created, and different imaging techniques were performed: conventional periapical radiograph; mesially and distally shifted periapical radiographs; cone-beam computer tomography (CBCT). Twenty students that had participation on dental trauma clinic at the year of 2019 were invited to identify root fractures by a five-point scale: (i) fracture definitely not present, (ii) fracture probably not present, (iii) uncertain whether fracture is present or not, (iv) fracture probably present, and (v) fracture definitely present. Data were analyzed by Kappa test for agreement evaluation. Comparing each student to the gold standard, there was a variation in reproducibility and performance from poor to substantial (0.042-0.667). Reproducibility values ranged from poor to good for all periapical radiographs both in the diagnosis of ORF (-0.33-0.667) and in HRF (0-1). In CBCT images, the students' ability was lower in HRF detection in comparison with the oblique ones. The students showed limited capacity to diagnose root fractures; however when CBCT was used, the performance was more satisfactory than when periapical radiographs were used.

Expect postoperative care disruptions for orthopaedic trauma patients during the COVID-19 pandemic: a retrospective review of patient care trends

Background: With the global COVID-19 pandemic arriving in New York City (NYC) public health measures were instituted to prevent disease spread. Orthopaedic trauma continued despite the pandemic, and patients were left attempting to obtain postoperative care while the city’s focus shifted to the pandemic. The purpose of this study was to evaluate postoperative care of patients treated for orthopaedic trauma during the COVID-19 pandemic in NYC and identify areas for improvement in the event of an expected second wave. Methods: All patients who received operative care for orthopaedic trauma during the pandemic time period by two fellowship-trained orthopaedic traumatologists were identified, and their records were reviewed. Results: Forty-nine patients were included for analysis. Six patients (12%) tested positive for COVID-19. Six of 24 patients (25%) who were recommended to be discharged to inpatient rehabilitation refused. Of the 31 patients discharged home, nine patients (29%) refused in-home services. Thirteen of 31 patients (42%) reported a delay in receiving outpatient physical therapy, and five patients (16%) reported difficulty filling prescriptions. There were 1,814 scheduled visits in the orthopaedic trauma clinic from March to May 2019 with 1,126 attended visits (62%). During the pandemic there were 295 scheduled visits with 175 attended visits (59%, P=0.367). At the peak of the pandemic in April 2020 there were 58 scheduled visits with 27 attended visits (47%, P=0.017). Conclusions: Patients treated for orthopaedic trauma during the COVID-19 pandemic were at increased risk of improper discharge, delay in outpatient services, and absent follow-up, which may together pose an increased risk of adverse events. Level of Evidence: Level IV.

Perineal Outcomes After Delivery in 179 Mothers with Inflammatory Bowel Disease Compared to 31 258 Controls: A Single-Centre Cohort Study

Women with inflammatory bowel disease [IBD] have an increased risk for caesarean section [CS], but perineal obstetric outcomes, which may have significant consequences for women with IBD, have not been previously studied. Maternal outcomes in singleton pregnancies of IBD and non-IBD patients [2014-2018] in a single centre were studied. In 31 528 non-IBD and 179 IBD patients delivery by CS was more likely in IBD patients (p = 0.0021, relative risk [RR] 1.45, confidence interval [CI] 1.16-1.81). Elective CS in IBD patients occurred in 40% for IBD indications, all in accordance with current international guidelines. Perineal trauma, including tears involving the anal sphincter, were equally uncommon in IBD [2.23%] and non-IBD patients [3.40%; p = 0.35, RR 0.64, CI 0.24-1.68]. Of the four IBD patients with clinically significant tears, none had pelvic floor dysfunction or incontinence at follow-up in a specialist postnatal perineal trauma clinic. One IBD patient who had a clinically non-significant second-degree perineal tear reported incontinence a year after giving birth. Previous perianal disease was not associated with significant perineal trauma. The low rate of perineal trauma is reassuring for promotion of vaginal delivery in most IBD patients. In those who experienced tears involving the anal sphincter no continence issues occurred. Women with IBD having a greater incidence of delivery by CS was only partially explained by IBD indications.

Comorbidities and medical complexities of mobility device users: a retrospective study

Objective To determine the medical complexities and comorbidities of individuals who utilise wheeled mobility devices. As well as, to examine costly events including the number of urinary tract infections (UTIs), hospitalizations, urgent care(UC)/emergency department (ED) visits that are commonly seen in this population over a period of time one year prior to and one year post receiving their wheeled mobility equipment. Design/Setting A retrospective data review of 857 individual medical charts at a Level 1 Trauma Hospital and Clinic System Participants 330 male and female (24–92 years old) mobility device users with a wide range of diagnoses, of which: 56 used manual wheelchairs (MWC),138 scooters (POV), 123 power wheelchairs without integrated standing (PWC), and 13 power wheelchairs with integrated standing (iS-PWC). Results Overall, 92% (n = 304) had at least three medical comorbidities and medical complexities. The most common comorbidity was pain (91%). A change was noted in a lower incidence of UTIs in those using an iS-PWC, respectively 23% with at least 1 UTI in the year prior to and 8% in the year after the mobility device evaluation. Conclusions The large number of comorbidities and medical complexities amongst all mobility device users is concerning. The burden and the accompanying healthcare costs of this population is high. The potential that iS-PWC and other interventions could have on reducing these issues should be explored further. Implications of rehabilitation Regardless of a person's primary diagnosis or the wheeled mobility device they use, 100% have at least one and 92% have at least three comorbidities and medical complexities if they spend the majority of their day sitting The high healthcare cost situations such as Emergency Department visits, Urgent Care visits, hospitalizations, and Urinary Tract Infections are present across those that use all mobility device types and the means to potentially reduce these incidences should be further explored The introduction of integrated standing within a power wheelchair, as a means to minimize the frequency of comorbidities and medical complications, should also be investigated further

Pain Appraisals in Patients with Physical Injury: Assessing the Role of Distress Tolerance in the Relationship between Depression and Pain Catastrophizing.

Pain is a complex construct contributing to significant impairment, particularly among physically injured patients seeking treatment in trauma and orthopedic surgery settings in which social workers are an integral component of care. The biopsychosocial theory, fear-avoidance, and cognitive mediation models of pain suggest that psychological factors (for example, depression) affect one's ability to tolerate distress, leading to negative pain appraisals, such as catastrophizing. This study examined whether distress tolerance serves as a mechanism by which depression is associated with pain catastrophizing. We administered a health survey to outpatient trauma and orthopedic surgery clinic patients who were using opioid medications; 84 patients were included in the final analysis; 39.3 percent screened positive for depression. A multilevel mediation model using structural equation modeling revealed a significant direct effect from depression to pain catastrophizing (ß = .31, z = 3.96, p < .001) and a significant indirect effect by distress tolerance (Δß = .27, z = 3.84, p < .001). These results, which suggest that distress tolerance partially mediated the path from depression to pain catastrophizing, can inform social workers and other members of the multidisciplinary team about both the critical role of psychosocial factors after injury and interventions to improve postinjury recovery.

The role of comprehensive geriatric assessment in the complex management of senior patients with hip fracture

The increased incidence of hip fracture in the frail elderly patients requires the development of differentiated care, adapted to their physical, psychological and emotional profile. Pre- and postoperative comprehensive geriatric assessment (CGA) is the most accurate tool for developing a personalized therapeutic and care plan. Aim: To investigate the consequences of the surgical treatment of hip fractures on senior patients using CGA preoperatively and in the immediate postoperative period. Material and methods: The prospective study, from which we present the preliminary data, was conducted on a group of 95 patients admitted in the Trauma Clinic with hip fracture. Of these, only 59 underwent CGA preoperatively and 48 hours postoperatively. Particular attention was given to frailty - evaluated with Groningen Frailty Index (GFI), neurocognitive status - evaluated with Mini-Mental State Examination (MMSE), and psycho-emotional status - evaluated with Geriatric Depression Scale (GDS). Results: Analyzing the GFI scores (p = 0.014) it was found that of the preoperatively robust patients 71.4% became frail postoperatively. No statistically significant differences in cognitive and psycho-emotional status were found in the immediate postoperative compared to the initial preoperative assessment, probably due to the small sample size. Conclusions: The results of this study confirm the importance of evaluating the degree of frailty for the prediction of the postoperative evolution of hip fractures in senior patients.

Impact of an Orthopedic-Delivered 'One-Stop' Clinic for Ambulatory Trauma on Emergency Department and Fracture Clinic Pressures During the COVID-19 Pandemic.

Introduction: In March 2020, the World Health Organization declared the severe acute respiratory syndrome (SARS) (coronavirus disease, COVID-19) outbreak as a pandemic. In response to the rising number of coronavirus cases in the United Kingdom, the British Orthopaedic Association (BOA) issued a series of emergency guidelines for the management of trauma and orthopedic patients during the pandemic. In line with this guidance, the orthopedic team at the Worcestershire Royal Hospital set up a ‘one-stop-shop’ minor injuries unit (MIU). This seven-day service provided a direct pathway to the trauma clinic for ambulatory patients who would usually be managed in the emergency department (ED), intending to reduce both the pressure on the ED and the need for further follow-up appointments. The aim of this project was to evaluate the service provided to patients and to inform our practice during the next stages of the pandemic and beyond.Materials and methods: Data were collected retrospectively from a clinic database, dictated letters, and scanned patient notes. The data collection period was over six weeks from April 6, 2020 to May 18, 2020. Data collected included patient age and gender, time of arrival and departure, grade of reviewing clinician, diagnosis, treatment, and outcome of clinic attendance, including the timing of follow-up.Results: Some 700 patients were seen in the MIU over six weeks. Some 98% of patients were seen by an orthopedic registrar (resident) or a consultant (attending) and 85% were seen and treated within an hour. Some 71% of patients were discharged after their initial appointment, and only nine patients (1%) required a fracture clinic appointment within 72 hours. A total of 15 patients (2%) re-attended with concerns, and just four of these required additional interventions.Conclusions: We delivered a seven-day minor injuries service in which the majority of patients received definitive management at first attendance, reducing the demand for fracture clinic appointments. Some 700 patients who would have been treated in the ED were seen in the MIU instead, relieving pressure on the ED. The lessons learned allowed us to plan for the 'second peak' in COVID-19 cases and will inform ongoing practice as we work to recover elective services.

880 Improving the Acute Knee Injury Pathway – A Regional Quality Improvement Project in the Oxford University Hospitals

Abstract Introduction There are many patients being referred from A&amp;E to orthopaedic trauma clinics in OUH for suspected ligament or meniscal damage, without convincing evidence of injury. This has led to demand for providing point of care ultrasound and streamlining of the referral process. Method We conducted an audit of all A&amp;E presentations at the OUH receiving a knee XR across 3 months and tracked their investigative and referral progress. Results: Conclusions Only 30% (57/182) patients referred to the Trauma clinic were deemed to have a serious ligament or meniscal injury. It is difficult to assess the extent of knee injury without specialist diagnostic equipment, which includes MRI or point of care ultrasound. This project has resulted in new trial protocols exploring the use of these technologies to improve this pathway.

885 Telephone Consultations During the Covid-19 Pandemic; from the Perspective of One Oral and Maxillofacial Unit

IntroductionThe Covid-19 pandemic has had a global impact on healthcare. As a result, changes have been made to healthcare provision. In the UK, the focus was changed to urgent and emergency treatment only, and therefore a shift from face-to-face consultations to video and telephone consultations was implemented. Our aim was to look at the telephone consultations in our oral and maxillofacial (OMF) department to identify their effectiveness.MethodA search was carried out using the electronic patient record for patients booked for consultations in the OMF clinics from the 23rd of March to the 1st of May 2020. Trauma clinics and ad-hoc clinics were excluded.Results21 clinic codes were found as suitable for inclusion. 185 consultations were booked during the 6-week period. Of these, 165 were via telephone and 20 face-to-face. A total of 75 consultations resulted in discharge and 110 required further follow up or further investigation. Of the 75 patients discharged, 73 of these were via telephone. The main reason for discharge was delivery of benign biopsy results.ConclusionsCovid-19 will have long term impacts on healthcare provision. If implemented correctly, virtual consultations carry the potential in making healthcare more accessible.

923 Accuracy of Assessment in Hand Trauma; Pre COVID-19 Face to Face Assessment Compared to Virtual Assessment During COVID-19 Lockdown

IntroductionThe Queen Victoria Hospital (QVH) was designated a cancer and trauma hub during the COVID-19 pandemic. With this, a new virtual hand trauma clinic was set up.We assess accuracy of assessment within this virtual set-up with comparison to pre COVID-19 face-to-face assessment.MethodTwo weeks of clinic sessions during and pre lockdown were analysed. Initial assessment was compared with the patient's operation note.ResultsIn the pre COVID-19 two-week period 129 face-to-face appointments were analysed. Of 99 patients that required surgery 77 (78%) had an accurate assessment. 6 were overestimated, 12 were underestimated.189 patients were seen over two weeks during lockdown via telephone or video call. Accuracy of assessment increased with seniority of the clinician. Of 126 patients that required an operation 109 (87%) had an accurate assessment; all structures injured were correctly predicted. 12 were overestimated, 5 had their injury underestimated.ConclusionsThe new virtual clinic allowed patients to be remotely assessed during lockdown, reducing footfall and unnecessary journeys.We found that virtual clinic assessments are accurate, and no patient underwent an unnecessary procedure. Using a telephone call plus photo gave similar accuracy as a video call.Virtual assessment was more accurate than face-to-face assessment.

496 The Use of Virtual Trauma Clinics (VTC) In the Assessment of Acute Hand Trauma; A Service Evaluation

Abstract As a UK tertiary referral centre for hand trauma the current COVID outbreak has led to the reconfiguration of trauma services. We evaluate the impact of our newly introduced VTC on our hand trauma service, comparing a cohort of patients who were managed pre-COVID, with our current revised pathway. We carried out a service evaluation of all those patients processed by the VTC over 14 days in April 2020 (n = 184). We collected prospective data on timing of referral to assessment and surgery. This data was compared to a matched period in April 2019 (n = 162). Post VTC there has been a significant reduction in time to clerking and time to surgery (p = &amp;lt; 0.001), with 98.1% being clerked within 1 day of referral. Post VTC 12.9% of patients were discharged directly from VTC, all other patients had definitive treatment in a single trip. VTC has shown a clear benefit to patients with definitive management provided in a single trip in all cases. Whilst we have been able to clerk patients earlier any improvement in time to surgery depends on theatre staffing and availability, which differed in the two cohorts and certainly will as we move forward into normal services.

Fracture Clinic

A certainty every spring is that warmer weather brings green grass, blooming flowers, monkey bars, trampolines and —pediatric fractures! With our trauma clinics starting to fill up, the aim of this installment of the JPOSNA “Coding Corner” is to equip you with the most up-to-date knowledge regarding fracture documentation and billing.

Effects of the first lockdown of the COVID-19 pandemic on the trauma surgery clinic of a German Level I Trauma Center

PurposeThe effects of the first pandemic wave on a German Level I Trauma Center should be evaluated to find ways to redistribute structural, personnel, and financial resources in a targeted manner in preparation for the assumed second pandemic wave.MethodsWe examined the repercussions of the first wave of the pandemic on the trauma surgery clinic of a Level I Trauma Center and compared the data with data from 58 other trauma clinics. The results could aid in orientating the distribution of structural, financial, and human resources (HR) during the second wave. The period between March 16 and April 30, 2020 was compared with the data over the same period during 2019. Information was collected from the HR department, central revenue management, and internal documentation.ResultsThe proportion of trauma surgical patients in the emergency room decreased by 22%. The number of polytrauma cases increased by 53%. Hospital days of trauma surgery patients in the intensive and intermediate care wards increased by 90%. The number of operations decreased by 15%, although the operating time outside of normal working hours increased by 44%. Clinics with more than 600 beds recorded a decrease in cases and emergencies by 8 and 9%, respectively, while the Trauma Center showed an increase of 19 and 12%. The results reflect the importance of level I trauma centers in the lockdown phase.ConclusionTo reduce the risk of an increased burden on the healthcare infrastructure, it suggests the care of trauma and COVID-19 patients should be separated locally, when possible.

Youth, poverty, and interpersonal violence: a recipe for PTSD

Substantial efforts have focused on physical rehabilitation to help speed the recovery process post-trauma. Despite intensive physical therapy, many trauma patients never return to their pre-injury status. This finding suggests...